Recreational Drug Use Among Primary Care Patients: Implications of a Positive Self-Report

Judith Bernstein; Debbie M. Cheng; Na Wang; Caitlin Trilla; Jeffrey Samet; Richard Saitz

doi:10.1370/afm.1750

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Author Response to Dr. Vinson's letter of 5/13/15
Judith A. Bernstein

Published on: 21 May 2015
Alcohol and drug problems are chronic illnesses
Daniel C Vinson

Published on: 14 May 2015

Published on: (21 May 2015)
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Author Response to Dr. Vinson's letter of 5/13/15
Judith A. Bernstein, Professor of Community Health Sciences
The authors of this study agree completely with Dr. Vinson about the importance of monitoring patients over time for issues that have the potential to affect health and wellbeing. Motivational interviewing certainly has merit as an intervention for unhealthy alcohol use, but we need to be cautious about thinking that a conversation about drug use will have a similar impact, because several recent studies in primary care a...
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The authors of this study agree completely with Dr. Vinson about the importance of monitoring patients over time for issues that have the potential to affect health and wellbeing. Motivational interviewing certainly has merit as an intervention for unhealthy alcohol use, but we need to be cautious about thinking that a conversation about drug use will have a similar impact, because several recent studies in primary care and other settings showed no long term effects on drug quantity or severity across a variety of substances(1). Motivational interviewing skills can certainly be useful, however, in eliciting information that clinicians can use to make appropriate referrals and medical decisions.
(1)Saitz R, Palfai T, Cheng DM, Alford DP, Bernstein JA, Lloyd-Travaglini, Meli S, Chaisson CE, Samet JH. Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial. JAMA 2014; 312:502-513. PMID: 25096690
Competing interests: None declared
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Competing Interests: None declared.
Published on: (14 May 2015)
Page navigation anchor for Alcohol and drug problems are chronic illnesses
Alcohol and drug problems are chronic illnesses
Daniel C Vinson, Physician
My thanks to the authors of this enlightening study. One way to apply their findings in practice is to identify alcohol and drug problems by screening. The problem might be relatively minor, like occasional heavy drinking or weekend drug use. But we can easily identify these issues, put them on the problem list (even though not even ICD-10 has a code for hazardous drinking or for recreational drug use). Then ask the pati...
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My thanks to the authors of this enlightening study. One way to apply their findings in practice is to identify alcohol and drug problems by screening. The problem might be relatively minor, like occasional heavy drinking or weekend drug use. But we can easily identify these issues, put them on the problem list (even though not even ICD-10 has a code for hazardous drinking or for recreational drug use). Then ask the patient next time you see them: "What's your pattern of drug use these days?" If they quit, as over a quarter of the patients in this study did, just thank them: "That's a healthy move you've made!" If use escalates, put your motivational interviewing skills into action.
These are chronic problems. None of us would treat asthma or hypertension with a one-off brief intervention and be done with it. We address it each time we see the patient, at least briefly. We can do the same with substance use problems.
Patients can change, and it's our privilege to help them.
Thanks, Dan Vinson
Competing interests: None declared
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Competing Interests: None declared.